Health Insurance in Practice: International Variations in Financing, Benefits, and Problems

Health Insurance in Practice: International Variations in Financing, Benefits, and Problems

Health Insurance in Practice: International Variations in Financing, Benefits, and Problems

Health Insurance in Practice: International Variations in Financing, Benefits, and Problems

Excerpt

The United States has serious difficulties in health care. Many persons lack financial coverage and services. Those with insurance protection often find it incomplete and must pay much additional cash. Costs cannot be controlled. Doctors and other providers are beset by complicated rules, burdensome paperwork, and disputes.

The United States appears unable to solve these problems. But all other developed countries have nationwide financing arrangements that either solve these problems or prevent them from arising in the first place. This book describes how other countries have taken voluntary and private health insurance— the method long used in the United States—and transformed it into stable systems of social protection for their entire populations. (The principal countries with these arrangements are Germany, France, the Netherlands, Belgium, and Switzerland.) The book describes these statutory health insurance systems in detail and contrasts them with the private and chaotic health sector of the United States on the one hand and, on the other, with the fully governmentalized arrangements ("socialized medicine") in a few other countries (such as Great Britain). The book concentrates on the countries with various mixes of social insurance and private insurance—that is, where subscribers pay premiums or payroll taxes into a fund that pays their health care bills—since these arrangements are plausible models for reform in the United States.I do not focus on the countries with government takeovers of the providers (as in Great Britain) or full public financing of health services (as in Canada), since the United States is unlikely to emulate them.

The book describes how countries with statutory health insurance solve the unavoidable difficulties in health care finance. Governments and insurance carriers respond in many different ways in capping total expenditures, controlling the reimbursement of providers, shifting some costs to patients, increasing payroll taxes, transferring money from other social security accounts and from the government Treasury, and so on. Costs must be controlled without cutting coverage and benefits, since they are guaranteed—universal entitlement was, after all, the reason for having statutory health insurance in the first place. Every country encounters other issues, as well, such as the administration of complex . . .

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